The challenge of managing coexistent type 2 diabetes and obesity

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We read with great interest your article: the challenge of managing
coexistent type 2 diabetes and obesity[1], and we congratulate you for the
high profile, comprehensive review and conclusions which had highlighted
important issues around the current available management of diabetes. We
share your views and anxieties however we noticed that little was metioned
about the revolution of metabolic surgery especially in providing long
term remission and cure in certain patients with type 2 diabetes.

We think the following points will be complementary to the educational
value of your important paper.

1.We have large body of evidence to support bariatric or metabolic surgery
for treatment of type 2 diabetes. For the first time in the medical history
we are now able to claim possible CURE rather than improve diabetes. In our
study of reviewing about 70 research papers, type2 diabetes can be
controlled and cured in a range 79-97% of patients underwent gastric
bypass procedures[2].

2.Efficacy of other types of bariatric surgeries such as gastric band and
sleeve gastrectomy is also promising and it can reach to 80 % of cases[3].

3.More aggressive procedure such as biliopancreatic diversion BPD,although
not very popular owing to high complication rate ,is also effective and
has comparable or even better rate of curing diabesity.Even for low BMI, BPD is controlling type2 diabetes in 83%[4].

4.The size of the problem of diabesity is huge as you have correctly
highlighted in the article and current UK resources to cope with the
problem is challenging. Increasing rates of obesity are contributing to the
growing numbers of people with Type 2 diabetes and it is estimated that by
2025 there will be 4 million people living with diabetes in the UK [5].

5.The NHS surgical service is providing great help to these patients, however the number of units and surgeons performing this kind of complex
surgery is still limited compared to great demands.If we are considering
and willing to tackle this challenge ,then we are expecting more
dedicated bariatric units.

6.Medical and surgical approaches are complementary and should be move
side by side to produce the best care for our patients.

If the adage`` a picture is worth a thousands words`` is true then
the picture not(animation)published with this article shows wrong
technique of injecting insulin,moreover the syringe used is also not
insulin syringe.